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0200 STEVENS STREET
C�mo 1:36- TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map - 3 9 Parcel Application # Health Division Date Issued Conservation Division Application Fee I i Planning Dept. Perm t Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/Hyannis a ri Project Street Address E&./ a 7ST � Village i in Y1 is Owner --YY) , k [4005 ej. ir.. Address g" Telephone J5'D,T— -7 -7 X Permit Request Zt) - L_LAM 6 9: R19r6Y AAID �I� h Square feet: 1 st floor: existing 40 proposed 2nd floor: existing If13q proposed _Total new Zoning District Flood Plain Groundwater Overlay Project Valuation -3,000 'Construction Type jN vy' ,,Lot Size 2f Grandfathered: ❑Yes ®'No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) .16 Age of Existing Structure i Q70 Historic House: ❑Yes U, o On Old King's Highway: ❑Yes ©-11101� Basement Type: ❑ Full 'Crawl Ll Walkout ❑ Other Basement Finished Area(sq.ft.) 10, Basement Unfinished Area (sq.ft) 3 Number of Baths: Full: existing �'(4n, new Half: existing new Number of Bedrooms: existing 0new Total Room Count (not including baths): existing ZZ, new First Floor Ana Count! ch .; Heat Type and Fuel: Q6as' ❑ Oil ❑ Electric ❑ Other - n _ Central Air: ❑Yes Cl<o Fireplaces: Existing New Existing wood/1 oal stove ❑ 2'N0 Detached garage: ❑existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ 'xisting OJnew;jsize_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ Not If yes, site plan review # Current Use �S !�/✓�+ /PGi / Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name v��v�7, � /bilk �o��f�yL7/as'� Telephone Number 7 7 Z- / i_ Address �o 30 K License # �S — 6 9 go (0 �. Pit/, 1141S4At l�V15� 40d 67,�L_ Home Improvement Contractor#I I ' i I: " E a ILV CO tY Ids Worker's Compensation # We-2--315 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ��r r el Z/y Z aP74 // SIGNATURE DATE P //Z// l .Y l FOR OFFICIAL USE ONLY - A PLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE e OWNER T , DATE OF INSPECTION: Y � • c r_FOUNDATION, k t � r FRAME ,F INSULATION - FIREPLACE ELECTRICAL: ROUGH FINAL I - PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING ` DATE CLOSED OUT ASSOCIATION PLAN NO. l r r C,y _ ep o n cc n Office of Investigations 600 Washington Street Boston,MA 02111 www.mass govA a Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers ARRUcant Information Please Print Legibly Name(Business/Organization/Individual): /Z;is Address: A 33 6,Y City/Sta /Zip:&tl&IMni N9,0,U,7Z Phone#: -7 Are y an employer?Check the appropriate box: Type of project(required): 1. I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or par�tuer me w �• [:]Remodeling and have no employees These sub-contractors have g, Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp.insurance comp.insurance.: required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.❑Other comp.insurance required.]. *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such- *Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: r' b?&L A4.z Policy#or Self-ins.Lic.#:WCZI—�i-s 3S/j�gg—!d /�gp Expiration Date: -3 I"7/Z 0 i4/ Job Site Address:200 _5114 t r City/State/Zip:/T1f�lji?i5, Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.`Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify der the pains and penalties of perjury that the information provided above is true and correct, Signature 6V"LL� Date: f/ /Z /7 Phone#• - — � a— Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone M Massachusetts General Laws chapter 152 s all 1 1 hap require employers to provide workers compensation for their emplo ,yam--_� Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of litT, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every,state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone numbers)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in.any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)"A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,-MA 02111 Tel.#617-727-4900 ext 406 or I477-MASSAF Revised 424-07 Fax#617-727-7749 w .mass.govfdia I � lime BARNSTASM MA W Town of Barnstable Regulatory Services Richard V.Scali,Interim Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street,:Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, IdAw"j-, &nt , as Owner of the subject l property hereby authorize au x. � to act on my behalf, in all matters relative to work authorized by this building permit application for: i ZOO 5 6V&-115 Srl /M (Address of Jobe Signature of Owner �. Date R1 01� �xZci.Lfl y�l-�rreG�c+ Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. Q:\WPHLESTORWbuilding permit formAsmokecarbondetectors.doc Revised 050412 4 +' ® DATE(MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 0/16/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER O'BRIEN'S CENTERVILLE INS AGCY INC CONTACT NAME: 259 PINE STREET PO BOX 610 PHONE (A/C,No CENTERVILLE, MA 02632 E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Liberty Mutual Fire Insurance23035 INSURED INSURER B: PAUL RUFO DBA RUFO CONSTRUCTION COMPANY INSURERC: PO BOX 648 INSURER D: WEST HYANNISPORT MA 02672 INSURERE: INSURER F: _ COVERAGES CERTIFICATE NUMBER: 18056853 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR I ADDLTYPE OF INSURANCE NAR SUER POLICY NUMBER MMI POLICY D/YYYY MM LTR I D//YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS-MADE 0OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PRO LOC $ AUTOMOBILE LIABILITY CO,acccidentsINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED 8 SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPER dentDAMAGE $ HIRED AUTOS AUTOS $ UMBRELLA LIAR HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1 DED RETENTION$ $ A WORKERS COMPENSATION WC2-31S-385298-013 3/7/2013 3/7/2014 TO STATUS RY LIMITS R OE7Fi- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N N/A E.L.EACH ACCIDENT $ 100000 OFFICER/MEMBER EXCLUDED? (Mandatory in NHI E.L.DISEASE.EA EMPLOYEE $ __ 100000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT- $ 500000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space Is required) THE WORKERS'COMPENSATION POLICY DOES NOT PROVIDE COVERAGE FOR PAUL RUFO Workers Com ensation insurance coverage armlies only to the workers Com ensation laws of the state of MA. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE BARNSTABLE HOUSING AUTHORITY THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 146 SOUTH STREET ACCORDANCE WITH THE POLICY PROVISIONS. HYANNIS MA 02601 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD CERT NO.: lee5b853 Anne Chagdler 30J16/2P013 5:1,3.43�!aee V10USlY 1SSUeC1 certificates. 1S certi icate cancels an S erse es 4' Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supen isor License: CS-094062 " PAUL A RUFQ P O BOX 648%' WEST HYAN]�TISPORT� v 0261 Expiration Commissioner , 12/01/2013: Ulae^�ppo�vr�vooacuectLCla o�C�/v�aaacec�icaeCt ' it I ;ense or registration valid for indrvidul use only Q, Office of Consumer Affairs`,&Business Regulaho�i f before the expiration date. If found return to: ME IMPROVEMENT CONTRACTOR egistration: 154862 Type - Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 xpiration: 4/10/2015,. DBA Boston,.MA 02116 RUFO CONSTRUCTIOTCL-Pi, r ` HAUL RUFO a:_.• L t' r 10 OLD TOWN ROAD HYANNIS,MA 02601 Undersecretary Not valid without si ture'. F Y` zoo ARCHITECTS Field Report 06 BHA ADAMS COURT,DHCD#020046 1215 BARNSTABLE BUILDING PERMIT#2.01207044, Observation Date: April 22,2013 Issue Date: April 23,2013 Contractor: Vareika Construction Inc. Writer: Rob Smith Weather: Sunny,breezy and cool. Construction deficiencies omitted from this report do not indicate acceptance of construction, assemblies or finishes observed, or relieve the Contractor of responsibility to install all work in accordance with the Design Documents. LOCATION Work in Progress: Building B&C work completed. Building D window installation is in progress.All small windows have been installed,large and paired windows in progress.Siding work is well under way,existing siding yet to be removed from south facing gable ends. Contractor uncovered encountered some termite/carpenter and damage,and has replaced plywood sheathing. Building A awaiting installation of additional windows;one Community room window also remains to be done. Observations: GC is maintaining a clean job site. Work continues to be very good quality. Window flashing is being installed per manufacturer's requirements. Interior trim work is consistently painted and caulked. Non-Compliant Items:None. J.M.Booth&Associates Inc. Tel no.508-999-6220 47 N.Second St.41h Floor Fax no.508-990-1265 New Bedford,MA 02740 www.jmba-architects.com rl� Jr f Bldg. gzi / East wall full shingle replacement,NorthBldg.D South1 1 in progress. - partial. i SS• ✓ I'� i �ay$as "R`� '.�'7'y i t a`q7 y1 �.. ,�`\.�ari,•Y �yY�. ,�, �"" �� •Y'.` Ulf a. � � -,."�y`� �� "'�l���e���'"i Bldg.D:So th wall to be derno'd. Bldg C:Completed East courtyard wall. r � r , � r �i{ j j ,�yi.l44�ik� •�t •.;4� �� �' ��; �•� �' y �tti.{��, 1 I 1�X 1�, f���e Art s •; f� t�i f.?'m"3" 1 saemaa:+ri 'A^'Via• • "1•� T � ( ,.� a�•"��>w� �:+ ' a�;� � �!+•.'g''�{t�lM j,� �.x.r tar'µ";ei+� � 1+�- F` �a}:: _ - - _•"",,-.--.,.. f � M"1 � + ..•a'4a V. i� ,�����1t ��� ara�� „..ua«�I��•,.".. .x� �' ., gy, may, " .._ 'Mr4�Y .."tt_,. ..+bl . ....`Ya..e. kf:�1K.'...niF. ..•.'4=,A'1'v,E'-`# ;./! �1• • / 1 1• � Iu ..1. • 1 1 '1 i BHA Adams Court Page 3 of 3 v k '"dhY� �i y+ v �= —a ~� 1 Y.MW.�••r+tMu�4M '4,rM"'t '.�tyKr"'!hl%.� 4- I �,�h *,��N'� ' '^G 14 i yTrrtr` '^kFrl r 1�sd r ,, ?� It, ,� i�"�,�u,..����"��.R r t tE ".*'" J,�?$ �^x'7K.'R`E``'`,„.�a,,.":�'f �qfl '�����ti�;.i7�s+Ehr�.�!�`•;ax�.+.'�'�i P'�� y +��'�-�"3 a�,�+'n 'I Completed Buildings B and C from site entry. s:\DATA\12\1215 BHA Adams Court DHCD\field reports\1215 Field Report 06.docx tllICL-TF CTS Field Report 03 Zoo S+e/eh BHA ADAMS COURT,DHCD#020046 1215 BARNSTABLE BUILDING PERMIT'#201207044 Observation Date:: February 19,2013 •Issue Date: February 25,2013 Contractor: Vareika Construction,Inc. Writer: Rob Smith Weather: Cold,cloudy.' Construction deficiencies omitted from this report do not indicate acceptance of construction, assemblies or finishes observed, or relieve the Contractor of responsibility to install all work in accordance with the Design Documents. LOCATION Work in Progress: Contract time has been extended to May 15`h to accommodate delivery and installation of additional windows per - Change Order 01. Work nearing completion on Building A. Shingling is wrapping up around new windows at rear.GC will revisit the building to replace windows included in recent change order. Staging is going up around Building B in preparation for new work. Observations: GC was maintaining a clean job site. Quality of work continues to be very good. Non-Compliant Items:None. Photographs: J:M.Booth&Associates Ina Tel no.508-999-6220 47 N.Second St.4`h Floor Fax no.508=990-1265 New Bedford,MA 02740 www.jmba-architects.com BHA Adams Court - Page 2 of 3 IT 49, a4 i h r� Rey a w k� Bldg.A East and South Elevations. Id .A West and South elevations. ��y�.�..�. .�..+,.�dn,•�.:�fi�•��• •'r,•r^.-'^ w � \ t K 1 ��r``�'P*'.'ip.+e+ i" � ik. '� .�tf F � � }-�� �•'�rt-ri��Y�"`R"�� :'t''�'s'� P}�. `y t 4�'"+ + �' 9 `s -4,, M1 .gEY. �+r y , r t } a ' �'� tau � $8t.�•� �v.+,��� �r��.'�•� � � �'! Bldg.A: Shingles at base and around new windows, Bldg.A:J-bead at rear entrance roof.a North elevation. h (�'c d•. r J+u/.J�•' ,ry> Si,.r,�t '�,�'+"14. by S Yid` 3Y.+j4rt 1. r'�` ��+.i S� •`.i�, a `# 'dtj - 3R - a P •;� Afj " 7 �4 �dy s 2 I.,.r. + ,•'F y=� T�, i S.,h dt. + �a.� s ,+� '1,` �_�%?__ r'y'-i Bldg.A:New window on North elevation. Bldg.A: Cedar corner,trim. "s:\DATA\12\1215 BHA Adams Court:DHCD\field reports\1215 Field Report 03.docx BHA Adams Court Page 3 of 3 .,: YW k� ii �o}p IAil 1 iS I tV.. t a .� a k)}` c Hai.• ro iY }J3 �++ "` 1 + po 1 ✓ G Ir I-.'t`� '� i•' -. � i.kt : ,; r L�.. .ra.`� Y'6?+�,. �t� �j}�, i"..? �?. -rt �r .l - p.•� s �'�' •. „+i �. i'. � - y �'�a M1 I x•�' {s�-h•r h'I'Is 1;;�� ��i�it t �r 4�1 x Xr. �, 'r�.'� 4 r'rx � } '��a�S#f �`>�r�`• Atli � '� �� ty�k��y�,`"�$��'qg?� ,any'=I ,'Y-+l wf.+r� '"& .+r �t >+t'e J°! 1:'YSt�' 'C�°' 3 �, .J ��•f'�i,+' t � '.4;s } - - - { - K A ��i:'�,�N a�.*.'1-R' >` .4- E 't I/# if �t�+�, �� '• �.�'v4�,{yyy�.<�'t tF`�a��rM � ,�,��^+'�"n` ,y,�'�� ��t�:•4Y -: y r1` A sec k $ { 4 A 1 t i'_ 1 s' ci ' ' Y W t 6 da t✓.w .'' fit« ;;� � ;- Ir • .�� `"`" J ,�a � 4 r 3•n �$ '$, } t � a t � /rva 9r S i f - '� 6'I s�l s Y•w Y, 7t ..3;t4"'��� Sn�t`x ,L I,f 4 k a Bldg.A:Reinstalled light fixture. Bldg.A:Hose bib trim with drip edge flashing. s,:\DATA\12\1215 BHA Adams Court DHCD\field rep6rts\1215 Field Report 03.docx k _ Cape Save Inc. T'Jtgl Oir ISARNSTAUBIt.F 7-D Huntington Avenue South Yarmouth, MA 02664 _ t, Tel: 508-398-0398 Fax: 508-398-0399 DIVISION 1-15-12 Z. Town of Barnstable Thomas Perry CBO Building Commissioner + 200 Main St. Hyannis,MA 02601 , RE: Building Permits Dear Mr. Perry, This affidavit is to certify that all work completed for 200 Stevens Steet Bldg A)Hyannis has been inspected by a certified Building Performance Institute(BPI)Inspector. Ceiling: R-30 Cellulose Walls: R-13 Cellulose dense pack Foundation Perimeter: R-5 fiberglass& R-7 Thermax All work performed meets or exceeds Federal and State Requirements. Sincerely, William McCluskey - •.Yaw: _. AKRO ASSOCIATES ARCHITECTS 27 Eastview Terrace, Marstons Mills, Massachusetts 02648 Tel & FAX: 508-419-1217 E-mail: akroassociates@aol.com 25 October 2012 Sandra Perry, Executive Director Barnstable Housing Authority 146 South Street Hyannis, Massachusetts 02601 Dear Sandee: This letter shall certify that I have inspected the work at 200 Stevens i Street in Hyannis and that the work is substantially complete as of the above date. All work has. been constructed in accordance with the con- struction documents and my directed field changes. Therefore, Rufo Construction has met the terms of the agreement dated 13 August 20.12. Attached is a punch list of items, that when accomplished will constitute final completion of the project. As previously discussed, because the re- siding and windows project will proceed directly following the completion of this project I have instructed Rufo to hold back on seeding at this time. I have discussed this matter with Paul Rufo and I recommend that the Barnstable Housing Authority withhold $300 as an allowance for doing this work. It seems to me that you might want to add this work to the siding project that follows or if the weather is not suitable for seeding at that time, simply have your maintenance department accomplish this in the spring. Should you have any questions or wish to discuss this further, please feel free to call. Very truly yours, Akro Associates Architects I Steven M. Shuman, RA Cc: Rufo Construction ZZ :6 �01 EIJI f"ViA M J0 ` i01 .............. ----------- PROJECT NAME: ADDRESS: j�2DO S PERAIIT# ? y9,C)s, o?o-1024Y�3�.dd� PERMIT DATE: M/P: FU q 40 LARGE ROLLED PLANS ARE IN: BOX a / SLOT ,g y Data entered in MAPS program.,on: BY: C,U, 1 x TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel d D f § Application # Health Division Date Issued 60 �� l Conservation Division Application Fee /OD Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address )-OD S 1 E n S 5 r79/J4—=t_-7-Q Village 141. an n I .S Owner &o f Dale Nuo si nG V Address 146 50UT IJ ST. ihifY ill-5 Telephone_ 60,9 - -11 v -7 22.3 Permit Request �Jew 51 X yD, /2T 066l< Square feet: 1 st floor: existing'31,40 proposed 2nd floor: existing300 proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation °� Construction Type Lot Size 21 f L4 I Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family units) Age of Existing Structure Historic House: ❑Yes YN'o On Old King's Highway: ❑Yes U<o Basement Type: ❑ Full S"C rawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft)3L/1 17 Number of Baths: Full: existing new Half: existing new 0 Number of Bedrooms: existing _new L� Total Room Count (not includingai baths): existing new First Floor Ro ount I56 Heat Type and Fuel: S/Gas ❑ Oil ❑ Electric ❑ Other / A3 Central Air: ❑Yes UNo Fireplaces: Existing New Existing wood/c al stove; ❑YSp /No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing 0,newpize_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use.Y_=2 es!�. t- :i -G-- = --- -Proposed Used APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name _ PA-1 w r, Telephone Number -77q_72_2_ - 9')5'Z Address Pb "80)� (.Ct� License # G G-D� W t J4 J!6: to VI 1!T1)rfi M! D��7Z Home Improvement Contractor# �5 ff6 2- Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE J OWNER ' DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth of Massachusetts ` Department of Industrial Accidents Office of Investigations - 600 Washington Street Boston,M4 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): . Address: City/State/Zip: IV -f III ahj Q247Z:Phone.#: Are you an employer? Check the appropriate box: Type of project(required):. 1.rI a employer with 4. I am a general contractor and I * have hired the sub-contractors6. [l New construction.. oyees(full and/or part-time).. 2. a sole proprietor or partner- listed on the-attached sheet 7. El ship and have no employees These sub-contractors have 8. D Demolition working for me in any capacity. employees and have workers' co insurance. 9. Building addition [No workers' comp.insurance. camp. required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 3.0 I am a homeowner doing all work officers have exercised their I I-F1 Plumbing repairs or additions myself. [No workers' comp. right 6f exemption per MGL . 12.0 Roof repairs insurance required.]t c: 152, §1(4),and we have no employees. [No workers' 13.[/KOther_&J&LO comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers',compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Cont actors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. 'I am an employer that isproviding workers'compensation insurance for my employees. Below is thepolicy and job site information Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: Z�!' $ �1/ B�; �� 1I(:f IVs , City/State/Zip:_'`�]rQy1_MM npOr Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure.to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment; as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification I do hereby certify under the pains and enalties ofperjury that the information provided above is true and correct Simafore: Date: Phone#: Of ttrial use only. Do not write in this area, to be completed by city or town official City or T. Permit/License# Issuing Authority(circle one): A.Board of Health 2.Building Department 3.City/Town,Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: . p�pF'I E r Town of Barnstable Regulatory Services BARMSPABLE, y MASS. g Thomas F.Geiler,Director p rF 019. to Building Divisio n Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstabl6ma.us Office: 508-862-4038 Fax: 508-790-6230 Property. Owner Must Complete and Sign This Section If Using A Builder I, IiG�G a Paw as Owner of the subject property.. hereby authorize 2tc, /�y/=0 to act on my behalf, in all matters relative to work authorized by this building permit. (Address of Job) **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. i tore o Ow er Signature of Applican J"4 \J Print Name $ Print Name Date BARNSTABLE HOUSING AMOAP . 146 SOUTH STREET WANNIS,AJA QZS01 QTORMS:OWNERPERMISSIONPOOLS 6/2012 oFtHl , Town of Barnstable Regulatory Services BMMSTABLE, : Thomas F.Geiler,Director 9 MASS. �p ED i6s9• a. Building Division J MA'I Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community: '• ,' R ; Q:forms:homeexempt Led,v, , Massachusetts -Department of Public Safety Board of Building Regulations and Standards {on'iru Ilion.Super%i;-or -- License: CS-094062 d I.S PAUL A RUFQ _ . P O BOX 64& WEST HYA$lTNISPOR MA' 026'1 r � piration _t Commissioner 2/01/2013 • .ram„-- •. • - - w T� 6rxv T(.r�rtcrtno�rraut� a ,Reg�rarli�J�sG/'i Office of Consumer Affairs&Busin ss Regulation _ ME IMPROVEMENT CONTRACTOR TYPe, .. istration 5466 pBA xpiration 4/1012013 - FIUFO ONSTRUCTI j PAUL RUFO 10 OLD TOWN ROAD HYANNIS,MA 02601 Undersecretary i. + _One 777 MEW Li , Y J4�16 wu n p_ n c i w moo S7tw sT _ t t s nail head T.p Nail flu_;h . o :E oard surface - do not sink slot; +yard surfacef decking. Use 2 nails per board at i E hci ist. Stagger butt joints 4' minimum. J,� � r, i1 ri new fdn. wall to existing fdn. wall using 18" long ba4s spaced vertical, @ 18" o.c. starting 12" from � ttorl' of existing wall. Pins to extend 6" into existing ;:v� r Anci 12" into new fdn. wall :Use Simpsom Set- L e) ' anchoring adhesive @ existing wall. Provide %Z : ri ,shalt impregnated ex-paswn joint @ each end of I(N 4� TTT I -k L4A_ tV rx Ckb ! 3� 1 . (J ns Street, Accessible Entrances at 200 Steveannis, a TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 3 7 Parcel I Application # I D Health-Division Date Issued -Z Conservation Division Application Fee Planning Dept. - Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation / Hyannis Project Street Address 0 +ere RS c71- Me aw Village Owner my l Lk Address ILI 6 coot I. R YX40s Telephone �.�.�. Permit Request el nA S be tiSe k. - . _ oS8 (10 C, UU01 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new T Zoning District Flood Plain Groundwater Overlay Project Valuation �� Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: AGas ❑Oil - ❑ Electric ❑Other Central Air: ❑Yes 4No , Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑existing ❑ neW size., Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: =' = Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial XYes ❑ No If yes, site plan review# :.}' Current Use Proposed Use Co APPLICANT INFORMATION (BUILDER OR HOMEOWNER) NA Name W �� S Cu vkY� Telephone Number 50 -3 —o Address 4C i millne.l-otl - V'Z License # c 0 7�6 5 h yrkrmok4k ( O 9..6 6 q Home Improvement Contractor# 10 11 Worker's Compensation #TW C 3 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO SIGNATURE DATE V r 'r n FOR OFFICIAL USE ONLY r k APPLICATION# F DATE ISSUED -E MAP/PARCEL NO. . is ADDRESS VILLAGE a OWNER 3. DATE OF INSPECTION: FOUNDATION 'Y F FRAME INSULATION Y FIREPLACE i 41' t ELECTRICAL: ROUGH FINAL X: PLUMBING: ROUGH FINAL GAS: ROUGH+ FINAL ,FINAL BUILDING 1. tr _ DATE CLOSED OUT ASSOCIATION PLAN NO. ,x - The Commonwealth of Massachusetts - Department of Indus&W Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.massgov/dia or ers' compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Aunlicant Information Pl"se Print Let>h Name(Business/organization bdMdual): Address: City/State/Zip:s—S • )(A MoSLVA. A0n 6VO Bonet Are you an employer?Check the appropriate box: Type of project(required)_ 1.911 am a employer with 14 4. ❑ 1 am a general contractor and t employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have.no employees These sub-contractors have g, ❑Demolition workingfor me in an capacity. employees and have workers' y aP �'• 9. [(Building addition (No workers'conip. insurance comp.insurance.* required-] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 11.[3 Plumbing rcpairs or additions myself. o workers' comp. right of exemption per.MGL 12.0 Roof repairs # insurance required.]t p c. 152,§1(4),and we have no �-t employees.(No workers' 13.®OrlerSi�W dti'ilM comp. insurance required.] *Any applicant that cheeks box#1 must also fdl out the section below showing their weskers'compensation policy information. *Homeowruss who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contracims that check this box must attached an additional sheet showing the tame of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees.they must provide(heir workers'comp.policy number. I ass an emploper that is praowfdfng workers'compensaton insurance far my employees Below is the policy andlob sine Information. , Insurance Company Name: I I -Ltt rah C on1 (� Policy#or Setf4ns.Lic.# T W C 3 9 ! '1" Expiration Date: 10 a.i�.a 0 Job Site Address: o Jena e. _ �, u,t' i n4 G City/Slateaip: Attach a copy of the workers'compensation policy declaration page(showing the policy numb and date). Failure to secure coverage as required under Section 25A of MOL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of�the DIA for insurance coverage verification. I do hereby certify under the pains d at'thes er}ury that the Information provided above is true and correct r D 01� F use only. o nut nirfte in t s area;to be contpteted by city or rown official.Town: Permit/LicenseAuthority(circle one): of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing inspector Person: Phone#: AC,9 CERTIFICATE DATE(MM,Do,YYYY) TIFICATE OF LIABILITY INSURANCE 10/20/2011 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate hoider.is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Shannon Sperrazza Risk Strategies Company PHONE (781)986-4400 IIFM :(781)963-4420 15 Patella Park Drive "MAILADDRESS,saperrazza@risk-strategies.com_ Suite 240 INSURERS AFFORDING COVERAGE NAIL# Randolph MA 02368 INSURERA:Selective Insurance INSURED INSURER B:Safety Insurance Company 3618 Michael McCluskey, DBA: Cape Save INSURER C.Technology Insurance Company 7 C Huntington Ave INSURER D: INSURER E: South Yarmouth MA 02644 INSURERF: COVERAGES CERTIFICATE NUMBER-CL11102041451 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE POLICY NUMBER MMIIDD EFF POLICY M DD/EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY RENTED PREMISES Ea occurrence $ 100,000 A CLAIMS-MADE ®OCCUR' PPS1994480 0/16/2011 0/16/2012 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY M JECT PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT a accident) BI t 1,600,000 B ANY AUTO BODILY INJURY(Per person) $ ALL OS OWNED SCHEDULED _ 208200 1/6/2011 1/6/2012 BODILY INJURY(Per accident) $ AUTOS X HIRED AUTOS M NON-WNED PROPERTY DAMAGEAUTOS $ (Per accident X Underinsured motorist Bls lit $100000 300000 X UMBRELLA LIAB X OCCUR PPS1994480 0/16/2011 0/16/2012 EACH OCCURRENCE $ 1,000,000 EXCESS UAB CLAIMS-MADE AGGREGATE $ 1,000,000 DIED RETENTION$ $ C WORKERS COMPENSATION Executive excluded WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N XER ANY PROPRIETORIPARTNERIEXECUTIVEfrom coverage E.L.EACH ACCIDENT $ 500 000 OFFICERIMEMBER EXCLUDED? � NIA (Mandatory In NH) TWC3297972. 0/21/2011 0/21/2012 E.L.DISEASE-EA EMPLOYE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500 000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,N more space ie required Issued as evidence of insurance. National Grid Corporate Services LLC d/b/a National Grid, d/b/a Boston Gas Company, .d/b/a Essex Gas Company, Action Inc., and Housing Assistance Corporation are listed as additional insureds as respects General Liability as required by written contract. S CERTIFICATE HOLDER CANCELLATION (508)790-2425 SHOULD ANY OF-THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN -Housing Assistance Corp ACCORDANCE WITH THE POLICY PROVISIONS. 484 Main Street Hyannis, MA 02601-3698 AUTHORIZED REPRESENTATIVE IMichael Christian/SMS ACORD 25(2010/05) 01988-2010 ACORD CORPORATION. All rights reserved. INS02617n1nn51n1 Thn ARr1t?11 n�mc and Inns�w wnic4ororl m�rirc of Af ARt1 — Office of Consumer Affairs and usiness Regulation r 10 Park Plaza - Suite 5170 • Boston, Massachusetts 02116 Home Improvement Contractor Registration r . Registration: 164432 Type: DBA Expiration: 10/6/2013 Tr# 217656 CAPE SAVE MICHAEL MCCLUSKEY 7C HUNTING AVE. S. YARMOUTH, MA 02664 Update Address and return card.Mark reason for change. DPS-CA1 0 SOM-M04-0101218 Address ["' Renewal. Employment r Lost Card � .�: ✓�t� 100I1bI100016I p �.� Office of Consumer Affairs&B mess Regulation License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: ' Registration: 164432 Type: Office of Consumer Affairs and Business Regulation _ Expiration: 10/6/2013 DBA 10 Park Plaza-Suite 5170 . Boston,MA 02116 C/�L SAVE MICHAEL McCLUSKEY 8201 S.HOURD CT �f CHAPEL HILL,NC 27516 � Undersecretary -- ot valid without signature Mussachusctts Depart tent of Public Safcte Board tW Building Regulations and Standards Construction Supervisor Specialty License License: CS SL 102776 Restricted to: IC WIl.LIAM MC CLUSKY m T1 37 NAUSET ROAD " WEST YARMOUTH,.MA 02673 j., .FA Expiration: 6/2&2013 <-msm uismer Tr#: 1 OZ776 t , i CAPEPSAVE Weatheirization 508-398-0398 a august 22, 2010 To Whom It May Concern: William J. McCluskey is any employee of Cape,Save. He is.authorized to negotiate contracts and building permits for our.company. Michael McCluskey Cape Save—Owner 3?.9-593-S939 cell Y . X Huntington Avenue,South Yarmouth,MA 02"4 • °F�► ,, Town of Barnstable Regulatory Services 9 mass g Thomas F. Geiler,Director Public Health Division Thomas McKean,Director - 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 EMERGENCY CONDEMNATION AND ORDER TO VACATE Finding of Unfitness for Human Habitation and Determination of Immediate Danger In accordance with M.G.L.c.1 l 1,,sec. 127A and 127B, 105 CMR 400.000: State Sanitary Code,Chapter I: General Administrative Procedures and 105 CMR 410.000: State Sanitary Code,Chapter II:Minimum Standards of Fitness for Human,Donna Z.Miorandi,R.S.,Health Inspector for the Town of Barnstable,on May 14,2003 conducted an inspection of a dwelling located at 200 Stevens Street,Apt.A-14,Hyannis,Massachusetts. The tenant's name in that unit is Ms.Harriet Dunham. Based on the results of that inspection,the Barnstable Health Department finds that the dwelling is unfit for human habitation. Pursuant to M.G.L.c. 127B and 105 CMR 410.831 (D),the Health Department further finds that the conditions within the dwelling are such that the danger to the life or health of the occupants of the subject dwelling is so immediate that no delay may be permitted in making this finding. Conditions found within the dwelling,which give rise to the emergency finding of unfitness and determination of immediate danger,include: 410.750: Conditions Deemed to Endanger or Impair Health or Safety 410.750(I) Failure,torcomply with any provisions of 105 CMR 410.600,410;601,or.410.;02 which results in any accumulation of garbage,rubbish,filth or other causes of sickness which may provide a food source or harborage for rodents,insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. The tenant,Harriet Dunham,had much open food and garbage,along with rubbish strewn about in the unit. The above items were scattered on the counters,tables,furniture and the floors. Stacks of dirty dishes. Old meat containers and wrappings left on top of stove. Many open plates of dog food on floor. Very filthy,unsanitary conditions inside the refrigerator and microwave as well as the oven. Used syringes left on baseboard heater in bathroom along with a bag of pie mix. 410.600: Storage of Garbaze and Rubbish The occupant of any dwelling shall provide as many receptacles for the storage of garbage and rubbish as are sufficient to contain the accumulation before final collection and locate them so that - a - t 4 no objectionable odors enter any dwelling. The tenant has caused objectionable odors both inside her dwelling and emanating,to the'outside . common areas affecting occupants of other dwellings in the building. Based upon these findings any and all occupants are hereby ordered to vacate and the landlord/owner is ordered to secure the subject dwelling within 48 hours of receipt of this order. If any person refuses to leave a dwelling or portion thereof,which was ordered vacated she may be forcibly removed by the local Board of Health(MGL. C. 127B),or by local police authorities at request of the board of health. Furthermore, anyone who fails to comply with any order of the board of health may be subject to fines ranging from $10-$500. Each day's failure to comply with an order shall constitute a separate violation. Once vacated this unit may not be occupied without the written approval of the board of health. Note: This is an important legal doe ent. It may affect your rights. Signed _.. Cc: Ms.Harriet Dunham,tenant ✓Mr.Tom Perry,Building Commissioner Chief Harold Brunelle,Hyannis Fire Department a Robert Smith,Town Counsel A Engineering Dept.(3r floor) Map (�9 Parcel d 04 3 Permit# f House# - 'Q Date Issued Board of Health(3r000r)(8:15 -9:30/1:00-4:30) r i-�l - ♦ ?Td- I Q� LNN Conservation Office 0th floor)(8:30-9:30/1:00=2:4 �NSTRUCRNgq .lq, Planning Dept. (1st floor/School Admin. Bldg.) Definiti Approved by Planning Board 19 �. r : BARNSTA L.E. 039. TOWN OF BARNSTABLE Building Permit p lication Project Street Address Village Owner c�C JiLS154K4 Address 74 yak 1_7_H " "_h-N N_AS ,NA Telephone e.9 ^ 72! < 7Z-Z Z _ Permit Request A_First Floor square feet Second Floor square feet Construction Type &A)--t,P (J _ fX���t0 (— Estimated Project Cost $ 63on r Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) 1 Age of Existing Structure Historic House ❑Yes ❑No On Old King's Highway, ❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New Half: Existing New ,No.of Bedrooms: Existing New A f Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use Builder Information Name r p ,--1�-N. �"�a si"(.� '�o Telephone Number !3'4 L(a Address $ jL}GL/1{ 6ZLI vF License# c S O S' 4--i 3 C� �-16-e a t 7-t H,1k O Z&-7 Home Improvement Contractor# Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO SIGNATURE _� DATE , 7_ AI&IJ /!F c� 7 BUILDINGfE MIT DENIED FOR THE FOAL OWING EASON(S) st �li. FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED r MAP%PARCEL NO. , p F , ADIlRESS VILLAGE' _ t OWNER DATE OF INSPECTION: r - FOUNDATION r t FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH ' FINAL - c.�`7.,C.,- FINAL - "• _ 1 r ,. .; f PLUMB��i :4 ROUGH w GAS: 4' ROUGH _ FINAL �v _ FINAUBUILDNWc- - 's::Fes, ,' , , i • DATE CLOSED OUT' t • •" a R. ASSOCIATION PLAN NO. g t r ' , F4J ` 71rc• CtIIIIIIIUIIIIIefilth Uf:Itusruchuticin ' Depurinrc•I11 of Industrial Accidents ANC-0-Of IffF9Sff9.7f%affS- 608 11 ushilr,;tuit Sirea 03111 Work-en' Compensation Insurance Amdavit �PPlic intinftirrnatinn •—• Pfc•�s'e PRINT'led�iily L/// - 'C 7:'i n n- S> 5 d4�t'iN-g- V qu 0 E 7��M r" 1 am a homeowner performing all work myself f am a sole proprietor and have no one working in any capacity I am an empiover prov;din_ workers compensation for mV employees`working on this job. cnn mm- n•tmt•- ltlrlrrcc• cit,• nhnnc f�' inmr^nrr rn noiicV>Y 7- 1 am a sole proprietor, general contractor. or homeowner(circle one) and have hired the contractors listed beiow who the "011ONvin= %vorke.rs compensation polices: Cntnr'lnl' nntnr• 1tirlrrcc• cir • nhnnc a• incnrnrr rn unlit, cum^ nc .nnmr. nddrr— tin•• nhnnc t1• incur^ncc rn nniic�• �^ Attach additional sheet if neressarv, � �� :.taLr� .. .—......tr. •....__�.. ....v: .--__3> —.a.. . ..... ..r�...z F;wurc to secure cuVer-icc as required under tecuon—"':A of NGL in can lead to the imposition of cnmtnai penalties 01 a line up to S1.S0uxu anurur unc cars' imprt+nnment:ts %cell as cil-ii penalties in the form of a STOP"'ORK ORDER and a fine ofS100.00 a dad•atzainst me. 1 understand that cop} 1rf thi..staicnicia ma, be fur„arded to the Oflice of Im-esticntions of the DIA for coverage Verification. I do herchr ccrrif t'un.Ue a i7nins and penalties of perjun•that Mc informarion prorided above is truer 7,j,,drrecr. atc Print name Phone 0 .+• rrr oRciai use uni do not write in this area to be completed by tiny or town ofliciai (t' ` cin•or town: permit/license d r tluildin=Department CLiccnsinc hoard 1.. Orr— check if immediate respunsc is rc uircd Q selectmen's Order . i 4 ["Iticatth Department t c phone#: conrac; ncl-Non: r'Utttcr� Inform:ition and Instructions Massacltuscttti General La►►•s chapter 15: section 25 requires all employers to provide workers W,rtpcits:t:it:n wnpturec is defined as every person in the service of ::nt,thcr under :::: emnitn ccs. As quoted i�t?m the "Law-. an contract of hire, express or implied. oral or written. An enrp/nrcr is dcfncd as an individual. partnership. association. corporation or other local entity. or an%, two or the fure_oInu en._n_ed in a joint enterprise. and includirtc the legal representatives of a deceased employer. or ;l;c recciver or tn,stee of an individual . partnership. association or other legal entity. employing employees. Howe. c m►•ner of a dwelling house Ravin; not more than three apartments and who resides therein. or the occupant of;he dN%cilia_-house of another`irlto employs persons to do maintenance ;construction or repair work on such dwellin__ C.— or oil the __rounds or iluilding appurtenant thereto shall not because of such employment be deemed to be an er p : MGi chanter !5: section 25 also states that eweri- state or local licensing ngency shall withhold the issuznce 01 ,,,�►::1 of a license or hermit to operate n business or to construct buildings in the common►►•enlilr for sny Jc.:rtt who leas not produced acceptable evidence of compliance with the insurance coverage required. neither the commonwealth nor any of its political subdivisions shall enter into any contract for:he pc::6rmz"::C of public work,Until acceptable evidence of compliance with the insurance requirements of this bec:: prc�:zntcd to the contracting authority. a1,l,iic::nts ('!.use 'ill in the workers' coin n pen affidavit completely, by checking the box that applies to your situation c:. sucpivin_ cotr:pany names. address and phone numbers as all affidavits may be submitted to the Department of ncustrIa1 .-accidents for contirtnation of insurance coverage. Also be sure to sign and date the affidavit. Tile -.'-'Vit Should be returned to 'ttte city or town that the application for the permit or license is being requested. :i:c De;a tn:e::t of Industrial accidents. Should you have any questions regarding the "law" or if you are o got in a ��ori;crs' compensation policy. pierse cell the Department at the number listed below. City or Fw ns Pfe �e -le ur: chat the affidavit is complete and printed legibly. The Department has provided a space at the bone:- aav it for you to fill out in the event the Office of Investigations has to contact you regarding tite applicant. F to fill in the permir/license number which will be used as a reference number. The affidavits may be return,: ,ne 'Dt;pamnent by mail or FAX unless other arran_t=ments have been made. Tile Dfi1cc of liwesticstions would like to thank you in advance for you cooperation and should you have any que=:: oiecse do not hesitate to _;-"e us a cell. Tile Deoarrnenr s address. teiepitone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents 5v - Office of Investigations 600 Washington Street Boston. .Ma. 02111 fax T: (617) 727-7 749 nilonc -" 6 i'1 --'900 c�::. 106. 109 or _ . 7ell' 0 m ru CD rki a ri _J . CL .1 7. ...r.. •'W 1 ' � ✓/re'�snwnA9zaroaliit of._,��Oddou�ndeldt_ nn . m Cestiir'.el ?�: 31 7 a I�EFRP1t{ICi O£ F9�f,IL �hPE1'i E4ASiRUCTIDR SUMVISM IRFAR oa Rober, Er.EitPfi: Aj.rlF,ir�e.. .l�, :Ia;,nrr yip CS MIDIS i r 7 Pirilti]rr?s Rest,ist^d to, �� ;d1)Uio r� 4ingcegc .9 rg1TpD!..erj?.11^.:1 i %fie is€srch�se?[s c?ar.e Puiildir!q rAe BRIM D PJ.RP.zSPA is Caase fn m,"atinrl ,>f thir lkea.?. � 12 tl���n �or�n • : !'� kT rn . T 7 c p - LL Q tA pl - m i i yo�THElo�y TOWN OF BARNSTABLE r EAHBSTADLL i "6 q 0 Y BUILDING INSPECTOR O•FPY Or APPLICATIONFOR PERMIT TO . ........................................................................................................................... TYPE OF CONSTRUCTION .....G!ll.l...P..ve......................................................................................................... ..�� .�..............19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for ermit according to the following information: s Location ....................................................................................................................................................................................... o / Proposed Use ............................................ ...... GG ...... ............"` ........ .............................................................. Zoning District .�j� <......................................................Fire District ............. �`�'� �`� ...................... ................................... Name of Owner612e ..............Address ...... Y. i L` ........................................... Name of Builder -.................Address ................. . ........................................ �✓ �. 2 Nameof Architect ........... ...................C;;.� ..........................Address ............. .................................................................... r Number of Rooms ....... .1,�7�..0 ........ .Foundation ...................................................... Exterior ... . ... ... ................ ........ . ...............................Roofing .... .................................. .: ........... Floors �✓ •�� Interior ................. �..... Plumbing ..:....-.......... Heating .................................................. ................(' ..........:......................... Fireplace ...... ..... ..............................Approximate Cost ........................... ......................................... .. .. ....... . . . . . Difinitive Plan Approved by Planning Board ________________________________19 Diagram of Lot and Building with Dimensions i� 9 9 SANITARY POSED METHOD O 1[D_ D WATER SUPPLY PPG4lIDING FOR RAINAGE IS y , SEA GE C)ISPOSAL , iYAPP" WN O� SEA j.-,� r Vsrn ED J�RM/T INSTAL AN� 1NSTgLt i SySUSr. �BT r. . 5z�� . A hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name � '� / .................. Barnstable Housing Authority y _ 1-0 DEC 31 1970 1 59 Housing for the I No ................. Permit for Elderly ............................................................................... I Lo cati �gtI ... Stevens Street. . ........................ ...... ............. ........ . .. Hyannis ............................................................................... Owner Barnstable Housing Authority Type of Construction frame ...................................................:............................ Plot ............................ Lot ................................ i Permit Granted Octob.er. .. ........1 ....19 69 ► .......... . .. .. Date of Inspectiog ..................19 y Date Completed ....... ..........19 ;;we PERMIT REFUSED iE ................................................................ 19 ............................................................................... f ................................................................................ R ............................................................................... ............................................................................... 1 • i Approved ................................................ 19 ............................................................................... ............................................................................. 1 1 6 tj'4V q 1 _TLa j ' r f,0 R.a �ru1 i,Dl�r9 two ....max-=—•--� :.,�-�._. _����_����—. _.�•-�• _ - .�-�.: - - I I f �_ -- J-1 ► -- - - _-_--------- 1 M r-AmF Ivk, ILA- f„1)1_)G'Pf►ON � New �{"_JA ,cn��t, �- N AULJCA e- £•U iA"',-To t/1}'. i R C-t,..lf OuT w ' o +-7" I Ur N UY IAZ - A GUT DUT y ` D KIP C.0 t--� c rear TO r F�EtKE=c'�t� ?�A �.� CD KC c j LAIF--7, ?P Co m r-1015tt ✓ ' t P.A&5E.�q5 u i ,�, �a IA8 .0 t w �+. N t;V�t •� 9 r 6 vr_ TDYSo I I,, To �v�- r _ Of w es to t i- • P V-.OY!PC if� •,�. tr- oil 4�T�PCAr�(�i t C 8/ t► /�7 KRO ASSOCIATES, AIA, ARCHITECTS �,. ,T � b� ',;; P"E ;,v 48 Camp Street, Hyannis, Massachusetts 02601 508- 778 - 6060 b ` ;oOf h ~� (�a� Steven M. Shuman, AIA Alice L. Oberdorf, AIA Joe vc)